Gram-negative bacteriemia in an hepatobiliary unit from a third level hospital

Abstract

Introduction: Bloodstream infections constitute one of the most severe forms of bacterial infection. Over the last two decades gram positive microorganisms predominated, but nowadays are almost equal as gram-negative ones. Central venous catheter and surgical site are the main origins of these bacteriemias in surgical patients. Material and methods: We analized all the blood cultures obtained from 2010 to 2017 from hospitalized patients in the Hepatobiliar Unit of a third level Hospital in Spain. We reported gram-negative isolation and bacterial resistance. Results: We documented 126 episodes of gram negative bacteriemia in 126 patients. Escherichia coli was recovered in 55.5% of cases, Bacteroides fragilis in 8.8%, Enterobacter cloacae complex in 8.8%, Klebsiella oxytoca in 8.8%, Klebsiella pneumoniae in 4.4% and Pseudomonas aeruginosa in 4.4%. The incidence of the episodes incresed progressively from 3 isolations per year to 13. E.coli bacteria have progressively become more resistant to quinolones, tetracyclines and some of them even to 3rd and 4th generation cephalosporines. We are also starting to report cases of E.coli able to produce extended-spectrum B-lactamases (ESBLS). Conclusions: The incidence of Gram-negative bacteriemia in the Hepatobiliary Unit has increased in the last seven years and E.coli was the most frequent isolated bacteria. We have to be careful with empirical treatment because we also reported an increase in the resistances especially in quinolones, tetracyclines and 3rd and 4th generation cephalosporines.